Provider Demographics
NPI:1447566799
Name:JASON R KOH DO INC
Entity Type:Organization
Organization Name:JASON R KOH DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-590-9447
Mailing Address - Street 1:PO BOX 3976
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-3976
Mailing Address - Country:US
Mailing Address - Phone:626-590-9447
Mailing Address - Fax:
Practice Address - Street 1:2840 LONG BEACH BLVD STE 465
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1594
Practice Address - Country:US
Practice Address - Phone:562-595-0790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10104208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADN975AMedicare UPIN